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Memorial Commemoration

The Co-op City Reading of the Names COVID Memorial

To submit information about a Co-op City resident who was lost to COVID-19, whose name will be read at a ceremony in September – October, please fill out the form below. Once we've received your submission, we will send you an email to ask if you'd like to include a photo to be included in a future publication.
1.What is the name of the person being memorialized?(Required.)
2.What is your name?(Required.)
3.What is your relationship to the person to be memorialized?(Required.)
4.Age of the deceased, if possible:
5.Your Address or Building Number:
6.Apartment #:
7.What is your phone number?(Required.)
8.What is your e-mail address for updates about the ceremony and questions:(Required.)
9.Please share a brief explanation of why this person was special to you?(Required.)
10.I hereby state that all information I have submitted on this form is valid and truthful and grant permission to the Riverbay Fund to use the name, likeness and memorial words written on this form.

I Accept: Please type your initials(Required.)